Obstructive Sleep Apnea (DC 6847): What VA Raters Look For

Obstructive sleep apnea is one of the most commonly claimed VA disabilities, and one where the rating criteria are unusually concrete: the levels are defined primarily by what treatment the condition requires, not by a symptom severity scale. That makes OSA a condition where understanding the criteria tells you almost exactly what the evidence in your file needs to show. Here is how DC 6847 works.

The four rating levels

OSA is rated under 38 CFR § 4.97, Diagnostic Code 6847. The schedule has four levels:

Note what the schedule is doing: each level above 0% is keyed to either a persistent symptom (30%) or a required intervention (50% and 100%). The question a rater asks is not "how bad does it feel?" but "what does the medical record document the condition requires?"

The diagnosis: it starts with a sleep study

Every level of DC 6847 presupposes a diagnosed sleep disorder, and for VA purposes the diagnosis rests on a sleep study (polysomnography or an approved home sleep test). The study report contains the apnea-hypopnea index (AHI) — the objective measure of how many breathing interruptions occur per hour.

A clinical note saying "patient reports snoring and daytime fatigue" is a symptom record, not a diagnosis. If your file does not contain a sleep study report, the diagnostic element of the claim is not yet documented — this is the single most common evidence gap in OSA claims.

The 50% level: what "requires" means

The 50% criterion — requires use of breathing assistance device such as CPAP — is where most granted OSA claims land, and the operative word is requires.

What the evidence needs to document:

• •A prescription. A sleep medicine provider prescribed CPAP (or BiPAP, or an equivalent device such as a mandibular advancement device) as medically necessary treatment — not as one option among several, and not as a device the veteran chose to try.
• •The clinical basis. The sleep study findings that led to the prescription.

What raters are not rating at this level: hours of nightly use, comfort, or symptom improvement. The criterion is that the device is medically required. Compliance data from the device can serve as supporting documentation that the prescription is real and active — but the legal criterion is the medical requirement itself.

Where CPAP intolerance fits

A veteran who cannot tolerate CPAP occupies a frequently misunderstood position. Two points from the schedule's structure:

• •If a breathing assistance device remains the medically required treatment — including an alternative device like BiPAP or a mandibular advancement device after CPAP intolerance — the 50% criterion continues to describe that situation. The criterion says "breathing assistance device such as CPAP," not "CPAP only."
• •If intolerance is documented and the condition persists with persistent daytime hypersomnolence despite (or in the absence of) effective treatment, that is the language of the 30% level — which is why treatment records documenting both the intolerance and the continuing symptoms matter.

The practical takeaway: records documenting what treatment was prescribed, what happened with it, and what the current medically required treatment is — in a provider's words — are what map your situation onto the schedule.

The 30% level: persistent daytime hypersomnolence

The 30% criterion is a symptom standard: hypersomnolence (excessive daytime sleepiness) that is persistent. Evidence that documents it:

• •Treatment records noting daytime somnolence across multiple visits — persistence is shown by recurrence in the record, not a single mention
• •Epworth Sleepiness Scale scores, if administered
• •Documentation of functional effects a provider recorded: falling asleep at work, while driving, during conversations

The 100% level

The 100% criteria — chronic respiratory failure with CO2 retention, cor pulmonale (right-heart failure secondary to lung disease), or tracheostomy — describe severe, objectively documented medical states. These are established by hospital and specialist records, not symptom reports.

What the C&P examiner documents

The OSA examination is records-driven. The examiner's DBQ asks them to document:

• •Whether a sleep study confirms the diagnosis, and its findings
• •Current treatment: whether a breathing assistance device is required, and which one
• •Whether daytime hypersomnolence persists
• •Any of the 100%-level findings

Two things veterans can usefully do at the exam: bring the sleep study report and the device prescription if they are not already in the file, and describe symptoms accurately and completely — including how the condition behaves with and without treatment. The examiner documents; the rater applies the schedule to what is documented.

The service-connection element

Everything above concerns the rating level. Service connection itself — the link between OSA and service — still requires the standard three elements, and OSA claims most often turn on the nexus. Common documented pathways include direct connection (symptoms documented in service, lay evidence of observed apneas during service) and secondary connection (OSA claimed as secondary to a service-connected condition, where medical literature and a reasoned medical opinion support the relationship). The nexus element is its own subject — see our guide on nexus letters for what that opinion needs to contain.

The bottom line

DC 6847 is one of the most evidence-legible diagnostic codes in the schedule: a sleep study establishes the diagnosis, a prescription establishes the 50% criterion, persistent documented hypersomnolence establishes the 30% criterion. The distance between your situation and the rating schedule is measured entirely in what your records document.